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TakeBack

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TakeBack's Latest Activity

  1. TakeBack

    Are NPs and PAs "Interchangeable"

    Thanks for all your feedback. I'm eager to hear more examples if you have them.
  2. TakeBack

    Are NPs and PAs "Interchangeable"

    This is a great example. I agree that out of the box an NP with this specialty focus in training and RN experience wins hands down. I still feel that I wouldn't NOT recruit a position excluding one group because, as you said, there are experienced PAs doing it. I just got an email job listing yesterday for a cardiac surgery position that was "PA or NP"; not many NPs in CTS but still best to keep it as open as possible.
  3. TakeBack

    Are NPs and PAs "Interchangeable"

    The question for me is how to recruit. Is it appropriate to recruit for a position SOLELY to one or the other. Do you post the Surgical job ONLY to PAs, the Family Practice SOLELY to an FNP, etc.
  4. TakeBack

    Are NPs and PAs "Interchangeable"

    Hello all, I am a PA and would like your feedback. When recruiting for any given position, do you feel that the hiring practice should have a preference for one credential over the other? E.g., should a Family Practice only/preferentialy recruit for an NP over a PA? Or a surgical group a PA over an NP? Or look at each and let the best candidate win? I'm interested in hearing your opinions, especially any of you who have been invovled in hiring decisions. Thanks.
  5. TakeBack

    Albumin/fluids and svr

    I think we're getting at the same idea from different sides.It's impossible to predict the result of one intervention (say, volume loading/increased SV) when the other variables are not fixed. It sounds like we agree that textbook scenarios don't uniformly apply to real pts. Regarding resistance, I am referring to both the static and dynamic aspects. The isolated contstrictive state of the VSM will have a dynamic effect on the flow generated by the CO (producing what we measure as the SVR). The degree of vasoconstriction produces the variable SVR in our calculations (using CO and MAP). Analagous to peak and plateau airway pressures.
  6. TakeBack

    Albumin/fluids and svr

    It is really difficult to say that volume loading will have any absolute effect on SVR. Resistance results from the interplay of flow (CO) and vascular tone. With fixed tone and CO the SVR would increase with IVF. However EVERY pt responds differently- the degree of change in the SV (ventricular compliance variability), vasodilation (vascular compliance variability) and HR response (chronotropic variability) makes it nearly impossible to predict. Experts on hemodynamics tend to agree that it is a bedside, case-by-case titration model which requires constant feedback to determine the individual results.
  7. TakeBack

    Albumin/fluids and svr

    The main reason they require volume is due to the massive third spacing from cardiopulmonary bypass/inflammatory response, and the use of vasodilating agents for anesthesia and postoperative sedation. The thoracic pump mechanism you are suggesting would really only applies to the chest when it is open, during the case, not afterward.
  8. TakeBack

    Amiodarone help!

    why was the pt unresposive w/ a SBP 180? 300 amio IVP is usually given w/ VF/unstable VT. This sounds like hemodynamically stable VT if I'm reading you right.
  9. TakeBack

    Another question about Amiodarone

    The pacer will protect the pt from bradycardia caused by dual therapy, but NOT from potential ventricular arrhythmia 2/2 dig toxicity. Levels should be monitored.
  10. TakeBack

    PA's make more $$ than NP's?!

    Here's the latest comparison, PA-NP head to head per specialty In some the difference is marginal, in others, significant. National Salary Report 2011 on ADVANCE for NPs & PAs
  11. TakeBack

    Nitro vs Morphine

    noncardiac chest pain- musculoskeletal pain esophageal spasm pneumonia/pleuritis PTX abd source etc
  12. TakeBack

    static electricity & temporary pacers/cvc's

    I've never seen it happen. A central line would be essentially impossible since the line material is nonconductive. There is a theory that exposed temp pacer leads can deliver static discharge. Check this out, from 1977: http://www.ncbi.nlm.nih.gov/pubmed/842445
  13. TakeBack

    tachycardia, left pneumonectomy

    Bengin in spectrum of postoperative complications, overall arrhythmias, and epidemiologic data on liklihood of acute decompensation. Numbers are numbers.
  14. TakeBack

    tachycardia, left pneumonectomy

    certainly- just sharing my clinical experience. My Masters specialization was in AF and I have taken care of easily >1000 AF pts. Most tolerate it, FWIW. Instability is rare and the most common reason they seek treatment is palpitations/anxiety/fatigue. Postop AF is a different animal than outpt lone or valvular/myopathic AF. That said, even very fast rates are often tolerated with mild/mod symptoms.
  15. TakeBack

    tachycardia, left pneumonectomy

    AF in and of itself is benign. Having dealt with easily >1000 pts with AF, most tolerate it very well. I have had to cardiovert pts for instability but it is rare. As I said above the greater risks are from the treatment not the condition, as you were getting at- anticoagulation, as well as the toxicity of antiarrhythmics. There are literally millions of pts in the US walking around with AF on a daily basis. Pradaxa is a tricky drug and it has causes major bleeding problems in those pts who requires urgent surgery while on it. Warfarin is not going away any time soon. Remember (OP) as well if you see a persistent 140-150 rate which seems regular you may be dealing with flutter which can be easier to convert.
  16. TakeBack

    tachycardia, left pneumonectomy

    There will typically be some shift after pneumonectomy. The concern for shift is with a tension situation- pneumo or hemo. Tension effects re assessed with echo, invasive monitoring numbers (swan) and clinical parameters.